This invention relates generally to stabilization of medical devices, and more particularly to stabilization of devices that enter or cover the nose and/or mouth. Although most useful in a neonatal intensive care unit (NICU) setting, the advantages of the present invention are applicable to any patient age group or setting requiring such stabilization.
Infants requiring mechanical ventilation (assisted breathing) are commonly treated by endotracheal intubation, wherein a flexible tube is inserted into the mouth, down the throat and through the lumen of the trachea a predetermined distance, to deliver oxygen to the lungs. In addition, flexible feeding tubes may also be inserted through the nose or mouth, passing through the esophagus, and terminating in the stomach or lower intestinal tract.
Serious complications can result from accidental extubation (dislodgment) of these tubes, including acute hypoxia, bradycardia, and long term laryngaltracheal damage from reintubation. Therefore, it is critical to prevent accidental extubation. Traditionally, stabilization to prevent accidental extubation has been accomplished by securing the tube to the face by wrapping an adhesive tape around the tube and adhering the tape ends to the patient""s face.
However, adhesive tape stabilization methods provide poor fixation, allowing the tube to move when the skin is stretched. The tape obstructs the face, has the potential to obstruct the nasal openings, and loosens with time. Tape is difficult to remove and reapply when adjustments to the tubes are required, often causing injuries to the skin by stripping away the epidermis, especially in premature infants. Tape adhesion methods have a further disadvantage, in that nasal and oral secretions are absorbed by the tape, causing the tape to lose adhesion and loosen, while contaminating the tape with microbial organisms that could colonize the patient and gain direct access to the lung via the endotracheal tube and cause pneumonia.
Mechanical ventilation applies a pulling force on the tubing. As a result of this pulling force, an improperly stabilized tube may cause pain and discomfort if the tube slides up and down within the trachea, especially if it hits against the bifurcation of the trachea. Moreover if the tube protruding outside the patient kinks, gas flow will be obstructed. Movement of the tube may cause it to extend and enter the right main bronchus, effectively removing the supply of oxygen to the left lung, or it may extubate completely, removing the supply of oxygen entirely. Such movement of the endotracheal tube in the small premature infant is a major clinical problem. In these patients the trachea is so short there may be only a few millimeters of discretionary tube movement before one of the above complications ensues.
Systems used to increase tube stabilization and limit tube movement have included bite block and neck strap combinations to fix the tube in position; a band extending across and adhered to the full width of the infant""s face, wherein the band contains tube receiving receptacles at predetermined locations; adhesive straps with a central opening over the mouth containing various tube locking means; and a flexible bar placed above the mouth and adhered to the infant""s cheeks.
With the exception of the bar, these known stabilization attempts have covered the patient""s mouth and portions of the tube, making oral hygiene and tube visualization difficult. These devices further require the endotracheal tube be placed within the device prior to intubation, thereby blocking the clinician""s visualization of the trachea and increasing the difficulty of successfully placing the tube in its desired location, making the device potentially dangerous.
While known bar stabilization systems do not have the foregoing disadvantages, these known bar systems rely solely on adhesion through cheek pads which have no mechanical clasping. Therefore, the bar is permitted to torque, allowing for excessive movement of the bar and excessive movement of the attached tube. Additionally, the tube can rotate around the bar, allowing it to kink in the patient""s larynx, restricting air flow, or placing extended tube pressure on the palate, causing interference with normal palatal development.
In an attempt to relieve palatal pressure, plates have been designed to rest on the tube to prevent tube extended contact with the palate. However, these plates interfere with oral hygiene and are difficult and clumsy to place properly.
What is needed is a stabilization method that allows for securing tracheal and/or gastric tubes and other medical devices without applying tape to the face, maintains visibility of tube markings, and keeps the infant""s face visible to parents and caregivers. It should also prevent kinking of the tube and allow for attachment of additional anchorage when heavier loads (such as nasal continuous positive airway pressure (NCPAP) prongs) are applied, and prevent oral secretions from collecting and interfering with adhesion and/or causing infection.
By conceiving a method to stabilize medical devices that enter or cover the nose and/or mouth using mechanical advantage along with adhesives, the present invention fulfills this need, and further provides related advantages.
The present invention provides an apparatus and a method for stabilizing at least one medical device such as a tracheal or gastric tube entering or covering at least one facial cavity such as the mouth and/or nose. The present invention takes advantage of a transverse stent containing a docking platform to secure patient tracheal and/or gastric tubes without the need to apply tape to the face, while maintaining visibility of tube markings, preventing kinking of the tube, and keeping the infant""s face visible to parents and caregivers. The transverse stent is secured to the patient""s face using adhesive fixation and optional mechanical clamping. The novel present invention also allows for attachment of additional anchorage when heavier loads need to be stabilized.
In one form, the invention comprises a transverse stent comprising a superior border opposed to an inferior border, an inner surface and an outer surface. A first facial interface is attached to a first terminal end of the transverse stent, and positioned to adhesively adhere and mechanically clasp to a first side of a patient""s face.
A second facial interface is attached to a second terminal end of the transverse stent and positioned to adhesively adhere and mechanically clasp to a second side of a patient""s face. A docking platform attached to the outer surface of the transverse stent supports the medical device.
In a different form, the invention adds gutters positioned on the inner surface of the respective first and second terminal end proximate to the respective first and second facial interface to channel oral fluids away from the respective first and second facial interface.
One advantage of the present invention is that it provides an interface for the attachment of an assortment of medical devices that improves upon the limitations of current attachment methods. In particular, it avoids the use of adhesive tape applied to the face, while providing a more stable and a secure attachment of these devices.
Another advantage of the present invention is that it provides a stable tracheal tube holder and tracheal tube stent, thereby maintaining the angle the tube enters the mouth, and preventing movement or kinking of the tracheal tube. In this manner, the tracheal tube will not impinge upon the infants lip or palate, and therefore, will not negatively impact upon oral-facial growth and development.
Still another advantage of the present invention is that because the endotracheal tube is better stabilized, the risk of accidental extubation is significantly reduced. This increase in stabilization also prevents tube movement during mechanical ventilation, thereby lessening the potential for patient discomfort, desaturation spells and laryngal trauma.
Yet another advantage of the present invention is that the transverse stent is stronger and more resistant to bending and buckling than known stabilization systems. By providing the ability to easily add additional anchorage, heavier medical devices, such as nasal CPAP cannula, can be fully supported, thereby reducing patient discomfort associated with those heavier devices.
Other features and advantages of the present invention will be apparent from the following more detailed description of the preferred embodiment, taken in conjunction with the accompanying figures which illustrate, by way of example, the principles of the invention.